Background Image
Previous Page  11 / 20 Next Page
Basic version Information
Show Menu
Previous Page 11 / 20 Next Page
Page Background

Knee Surgery

ELEVEN

Knee Surgery

Ian McDermott is a Consultant

Orthopaedic Surgeon in the

London Sports Orthopaedics

Group, based at 31 Old

Broad Street, and operating at

London Bridge Hospital. He

specialises in Knee and Hip

Surgery including Arthroscopic

Surgery, Sports Injuries and

Joint Replacements.

Mr McDermott is an Honorary

Professor Associate at the

Brunel University School of

Sport & Education. In 2004,

Mr McDermott was the

youngest ever surgeon to be

elected as a Council Member

andTrustee of the Royal

College of Surgeons, and he is

also a Fellow of the Faculty of

Sports & Exercise Medicine.

In 2003, Mr McDermott was

awarded the President’s Medal

of the British Association for

Surgery of the Knee (BASK)

for his research into meniscal

repair. In 2004, he was awarded

a Master of Surgery higher

degree for his work on

Meniscal Transplantation. He is

also the Honorary Secretary of

the UK Meniscal Study Group.

Mr Ian McDermott

Consultant

Orthopaedic Surgeon

MB BS MS FRCS (Orth) FFSEM (UK)

London Sports

Orthopaedics

Secretary: Chloe Lilley

T: 08445 617 157

F: 020 7496 3596

[email protected] www.sportsortho.co.uk

‘BIOLOGICAL KNEE REPLACEMENT’

RECONSTRUCTION OF LATERAL

COMPARTMENT

Chondral

Graft on

Tibia

Lateral

Meniscal

Allgraft

Transplant

Chondral

Graft on

Femur

The very newest concept in soft tissue

reconstructive surgery of the knee

is to combine these techniques for

meniscal cartilage replacement and

articular cartilage replacement, with the

so-called ‘Biological Knee Replacement’,

for knees where one would otherwise

previously have had to resort to artificial

knee replacement surgery.This kind of

surgery is aimed at younger patients

with severe joint damage who have

severe symptoms, but who are deemed

too young for a knee replacement.The

concept was first popularised by Dr

Kevin Stone, a leading knee surgeon

in San Francisco. However, in the UK

we are fortunate in that many of the

newer surgical technologies (such as

Autologous Chondrocyte Implantation

or chondrotissue

®

grafting) do not yet

have FDA approval and therefore cannot

yet be used in the US, but they do have

approval for use in the EU which puts

UK surgeons at an advantage over our

US counterparts.

Mr McDermott is a leading pioneer in

the field of meniscal transplantation and

articular cartilage replacement surgery,

being the first surgeon in the UK to

combine these to perform a ‘Biological

Knee Replacement’.

CASE STUDY

A 30-year-old female presented with

increasingly severe pain and swelling

in her knee, restricting her activities.

She had previously torn a meniscal

cartilage when she was a teenager,

with the torn cartilage having been

surgically removed. Investigations

confirmed complete loss of her lateral

meniscus, with widespread erosion of

the articular cartilage on the lateral

femoral condyle and the lateral tibial

plateau, with large areas of bare bone

exposed.The patient’s knee alignment

was normal and the joint was stable.

After detailed imaging plus an

arthroscopic evaluation of the joint,

the decision was made to proceed

with a ‘Biological Knee Replacement’.

The missing lateral meniscus was

replaced with a donor meniscus, by

meniscal allograft transplantation.

At the same time, the areas of bare

bone in the knee were resurfaced

with chondrotissue

®

articular grafts.

The patient was in hospital for just

one night post-operatively, and her

knee was protected in a brace and

with crutches for the first six weeks,

followed by a six-week course of

physio rehab.The patient then spent

the next six months performing

carefully controlled exercises in the

gym.

The patient was reviewed nine months

post-op, and an MRI scan confirmed

that the lateral compartment of the

knee looked almost as good as new,

with a new lateral meniscus and with

a good layer of new articular cartilage

covering the end of the femur and the

top of the tibia.The patient was able

to walk normally, with no pain and

no swelling; she was going to the gym

regularly, and was advised that she was

well enough to return to full normal

activities.To date, one year post-op,

the patient is still 100% happy,

symptom-free and active.

Summary

The field of soft-tissue reconstructive

surgery in the knee is continuing

to develop, with novel and exciting

technologies becoming available on

an ongoing basis.The surgical options

available continue to expand, although

careful appropriate patient selection

is vital; as is choosing an appropriate

surgeon with the experience and

expertise necessary to deliver these

complex techniques.